Category Archives: Medical Education Law

By Ritisha K. Chhaganlal, J.D.
According to a study done by the Association of American Medical Colleges (AAMC), the number of students enrolling in medical schools has reached an all-time high.

In 2014, the total number of applicants rose by 3.1 percent. AAMC President, Darrel G. Kirch M.D., expressed concerns regarding the availability of residency training positions for aspiring doctors. Dr. Kirch stated: “As we face a worsening shortage of both primary and speciality physicians over the next two decades, Congress must increase federal support for residency training by lifting the 17-year-old cap on residency training positions imposed under the Balanced Budget Act.” To read the AAMC’s press release in its entirety, click here.

It is unsurprising that medical students across the nation are concerned about securing a residency position after graduation. However, an analysis conducted by The New England Journal of Medicine (NEJM) suggests that this General Medical Education (GME) “squeeze” is actually not as severe as many believe.

History Behind Medicare Resident Limit Caps.

The Balanced Budget Act of 1997 (BBA) was established to cap the number of residents and fellows for the purposes of calculating Medicare reimbursements against each hospital’s most recent cost report. There are a few exceptions; the BBA cap on the number of residents does not apply to new programs in underserved rural areas for three years. After three years, these programs are considered to have enough time to fill their residency cohorts.

The Medicare program is the largest source of funding for GME. Given this limit of funding, many believe that it will also limit the number of residents and fellows.

Analysis Indicates Growth in Entry-Level GME Positions.

The NEJM studied data from the Accreditation Council for Graduate Medical Education (ACGME), AAMC, and the American Association of Colleges of Osteopathic Medicine (AACOM), for the time periods of 2004-2005 and 2013-2014. The NEJM found that entry-level GME positions increased from roughly 25,000 in 2004-2005, to about 29,000 in 2013-2014. This is a total increase of approximately 4,000 positions. Additionally, the number of U.S. graduates with M.D. and D.O. degrees grew from about 19,000 in 2004-2005, to roughly 23,000 in 2013-2014. This is an increase of approximately 4,000 graduates.

If the number of GME positions increases as it has been over the past decade, it is projected that there will be approximately 34,000 positions for medical graduates entering their first year of residency in 2023-2024. The number of medical students is expected to increase due to newly opened M.D. and D.O. schools. As a result, it is assumed by AAMC that a 2.4% annual growth of medical graduates will continue onto 2023-2024.

In 2023-2024, the number of graduates projected will be marginally more than 29,500. With these numbers, there will be approximately 4,500 more open positions for residency than U.S. medical graduates in 2023-2024. While the number of positions available to graduates compared to 2013-2014 is less, the amount of GME positions will still significantly exceed the amount of U.S. medical graduates.

What Does this Mean for Medical Graduates?

Although the amount of GME positions will exceed the amount of medical graduates, the gap is still narrowing over the years. Over the past 50 years, medical graduates benefitted from “selection subsidy,” which allowed them to start residency at the location and in the speciality of their own choosing. However, the likelihood of a medical graduate finding the exact location and speciality he or she desires may not be an option anymore. Despite this, the most intense competition for these residency positions lies amongst the International Medical Graduates (IMGs). Although U.S. graduates will be affected by this slight “squeeze,” IMGs face an overall tougher road. To read one of our previous blogs focusing on future physicians, click here.

Comments?

Do you think there is not enough residency positions to meet the influx of medical graduates? Do you think Congress should fund more GME positions in order to create a larger margin for U.S. graduates?

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such indiviuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Vernon, Jamila. “More Students Going to Medical School Than Ever Before.” AAMC. October 29, 2015. Web.

“Why a GME Squeeze in UNlikely.” NEJM. November 4, 2015. Web.

“Medicare Resident Limits.” AAMC. Web.

“US Residency Training Before and After the 1997 Balanced Budget Act.” JAMA. September 10, 2008. Web.

About the Author: Ritisha K. Chhaganlal, J.D., is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone (407) 331-6620.